TRICYCLIC ANTIDEPRESSANTS;

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Introduction: Despite advancements in the treatment of depression and availability of newer compounds, TCAs likeamitriptyline remain to be the cornerstone of antidepressive therapy for more than three decades, however significantly more patients receivinga tricyclic withdraw from treatment mainly because of side effects. Higher response, lower incidence of side effects and improved compliancecan be enhanced by the optimal use of Therapeutic Drug Monitoring (TDM). No research data is currently available on the therapeutic drugmonitoring of TCAs in Pakistan. Objectives: To compare the relative efficacy of Tricyclic antidepressant in the treatment of depression, with andwithout Therapeutic Drug Monitoring Main Outcome Measures: Changes in HAMD scores in patients on TCAs. Study Design: A Quasiexperimental study design was used. Setting: The study was conducted at Department of Psychiatry, Military Hospital Rawalpindi. Subjects:34 patients completed the study in the monitored group (with TDM) and 33 in control group (without TDM). Methods: Serum TCA levels andHAMD scores at baseline and subsequently at sixth, eighth and tenth week of treatment were collected. In all the subjects, all the blood sampleswere drawn as a fasting sample in early morning. Results: The mean age of the monitored group was 31.97 years (SD=10.432) while that of thecontrol group was 33.52 years (SD=9.385). in the monitored group 20 (58.82 %) of the patients were males while 14 (41.17%) were females, inthe control group 22 (66.66%) were males and 11(33.33%) were female patients. A significant reduction in HAMD scores was noted at 8 weeksof treatment. The groups did not differ in terms of efficacy of TCAs, however the monitored group had fewer dropouts than the control group.Conclusions: Lower incidence of side effects and improved compliance can be enhanced by the optimal use of Therapeutic Drug Monitoring(TDM) of TCAs.